AIDS Work Today: Fighting a Changing Threat

When we reached out to the AIDS Services Foundation (ASF) for an interview, CEO Philip Yaeger kindly invited us to tour their headquarters in Irvine. He also answered questions about the ways AIDS prevention and care work together, and how the changing communities and attitudes currently surrounding AIDS shape these efforts.

RRD: For those who are unfamiliar, what is AIDS Services Foundation?

PY:  ASF is the largest provider of direct services to men, women and children living with HIV and AIDS in Orange County.  We have two main focuses.  Our first focus is to prevent new infections from occurring. We do that through HIV testing and HIV prevention initiatives.  Our second focus is to take individuals who are diagnosed or living with HIV, and address issues that get in the way of getting connected to medical care and treatment.  The research has shown that getting on treatment reduces the viral load within the system, causing the individual to become less infectious. So if we can get as many HIV+ individuals as possible identified, in care, on treatment, with a suppressed viral load, we reduce the infectiousness of our community.

RRD: The Positively Speaking program is a unique one to ASF.  Can you please speak a little on it?

PY:  We primarily visit health classes at high schools and colleges. It’s remarkable to have students sit there and listen to a blonde-haired, blue-eyed, thirty-something year-old woman who lives in Newport Beach talk about her ideal childhood and adolescence and marrying her high school sweetheart, and 10 years later finding out that she was infected with HIV.  And these kids can say “Wow, this could by my aunt, or my neighbor, or somebody else I know, but this doesn’t look like the gay individual or the IV drug user who I thought was living with HIV. This looks different; this looks like somebody I could bump into on the street.” People need to consistently hear about protecting themselves. We need to normalize HIV testing and remove that stigma as much as possible.

RRD: ASF provides a lot of services targeted towards the Latino population. Can you speak on why it’s so important to provide culturally relevant services to this, or any specific population?

PY:  We initially saw HIV affecting the gay, white community. And what we’ve seen over the last 15-20 years is a shift into communities of color. In Orange County, close to 50% of all new infections are occurring within the Latino community. And so it’s been important to us to make sure that every access point for our services is not only addressed with bilingual capabilities, but bicultural capabilities. It’s something that we believe very strongly in. If your clients don’t feel safe and comfortable coming there for services, then they won’t.

RRD: This economy has been rough on the non-profit industry as a whole.  How have you dealt with an increase in demand for your services coupled with a decrease in available funding?

PY:  Beginning back in 2008, we took an immediate and aggressive response to the downturn in the economy by eliminating eleven positions, consolidating offices, reducing our discretionary spending, rent and utilities expenses. We wanted to make sure that we were targeting our resources and efforts at programs that had the highest impact and reached the largest number of people. We have had to cut back in some areas and rely more on volunteers and interns, but we’ve been able to maintain the core of our client services.

RRD: According to your annual report, there has been a large surge in demand for your transportation services (up to a 100% increase in some instances). Do you have any insight into why this could be?

PY: A lot of the basic services we provide such as food, housing and transportation have seen a dramatic increase. Many of our clients are on disability and are living below the poverty line. They might have had part-time jobs or minimal sources of income that were lost during the economic downturn. So folks who may have been able to afford a car lease payment in the past have found themselves in need of that transportation help just to get to a medical appointment. Others may have had a vehicle, but no longer have the resources to pay for gas.

RRD: Your recent client survey states that 98% of your clients believe that ASF’s case management services have made a significant impact on their quality of life.  With such striking remarks, can you please talk a little bit about what your case managers do?

PY:  One day, somebody may call who needs transportation to get to a medical appointment.  Another case that we are seeing more and more often is when someone is diagnosed in the hospital with AIDS, completely unaware of having an HIV infection.  Then all of these other complications arise: typically there are disability, housing and income issues that need to be addressed.

New clients receive an initial assessment and are placed in one of the four levels of case management. The first phase is social services, which usually lasts for at least the first 6 months. Now if someone comes in and they’re actively using substances or they’re homeless, or have active, untreated mental illness, a lot of times, they’ll go to the social work case managers right away because that’s an additional need. For clients who are diagnosed with AIDS in the hospital, a nurse case manager will often to take the lead in securing the necessary medical care and specialists. The very lowest level of case management is self-advocacy. Those folks know that they can pick up the phone and say I’m sick, or I just lost my job, or my wife just left, or I need to come in for mental health. Ultimately, if they can leave self-advocacy and say “I’m now working, and I no longer need food or housing, I’m great,” that’s our goal.

RRD: What are the current trends in new HIV infections?

PY: The CDC is sticking with an annual infection rate of 56,000. In Orange County, we identify about 350 new infections per year, so about one a day. About 25% [of new infections] are under the age of 25.  We’re also seeing a lot more women infected with HIV. Substance use, especially crystal meth use, is often what leads to an infection for many youth.

75% of new infections are being spread by people who don’t know that they’re HIV+. You sometimes hear the weird stories about people intentionally infecting others. The reality is that 97% of people, once they know they’re HIV+, do not infect others. They do everything they can not to infect other people. That’s why it’s so important for us to identify people, normalize testing, and get people on treatment. I know we’ve removed some of the stigma, because people are coming forward. We have a lot of women coming forward and saying “I don’t trust my husband.” There are often a lot of women who just don’t want to know, but now you’re seeing women who say “no, I need to be here.” We even have those situations where the husband will refuse to get tested.

RRD: AIDS Walk is coming up on May 6th. How do you go about planning such a large-scale event?

PY: We are so fortunate to have AIDS Walk at the Disneyland Resort.  Those guys know how to put on events and they know how to deal with large crowds. Our challenge then is to focus on building teams, because that’s really where we’re going to draw the greatest amount of participation and revenue from the Walk.

RRD: ASF, like many non-profits, relies heavily on volunteers to help out in many aspects of the organization.  How can people get involved and what kinds of opportunities are available for them?

PY:  We have opportunities for everything from food pantry help, to office receptionist help, to help and support with special events, which sometimes happen on the weekends for people who have limited availability. The easiest way to find us is to go to our website, www.ocasf.org, or contact Carolyn Spivak, our director of volunteer services and community outreach, at (949) 809-5771 or cspivak@ocasf.org. She can get a volunteer application sent out to anyone who might be interested.

RRD: After 18 years at ASF, what would you say is the most rewarding part of your job?

PY: It’s knowing that I’m making a difference in people’s lives. If I’ve prevented one new infection from happening, did I save that person’s life? Did I help someone get connected to care? Did I give them an extra couple of years? Hopefully we’ve done that many times over. But without knowing for sure, I can at least hope that we’ve made a positive impact on someone’s life.

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